The issue of Cuba’s health care record came up again recently after Sen. Tom Harkin (D., Iowa) visited the island in January, telling reporters afterward that Cuba is a “poor country” but “their public health system is quite remarkable.” He said Cuba has a lower child mortality rate than the United States and a higher life expectancy.

“I wonder if the government officials who hosted him, informed him that in Cuba there are instances reported, including by defectors, that if a child only lives a few hours after birth, they’re not counted as a person who ever lived, and, therefore, don’t count against the mortality rate,” he said.

Dr. Rodolfo Stusser, former adviser to the Cuban Ministry of Public Health, said in an email that the ministry has contrived its health data since Fidel Castro’s 1959 revolution.

Stusser conducted his own personal research on Cuba’s health care system since 1800, but has been unable to review more data in recent years. Officials at Cuba’s Health Statistics Bureau told him in 2009 that old archives had been lost in a fire.

Stusser presented research last year to the Association for the Study of the Cuban Economy (ASCE) showing that declining infant and gross mortality rates predated Castro’s takeover. However, health care successes in Cuba’s colonial and republican eras “have been systematically erased or distorted,” he said in the report.

Cuba had the 14th lowest infant mortality rate in the world in 1958, lower than France, Germany, Italy, and Japan. Cuba has the 42nd lowest rate today, according to 2013 estimates in the CIA’s World Factbook.

While Cuba’s infant mortality rate is lower than the United States, Stusser said Cuban authorities use heavy-handed methods to keep it that way.

Doctors in Cuba’s public health system are pressured to induce abortions for potentially problematic pregnancies in order to artificially lower the infant mortality rate. Stusser estimated that if the deaths of living fetuses older than 21 weeks had been reported, Cuba’s infant mortality rate would be at least 50 percent higher.

Katherine Hirschfeld, chairwoman of the anthropology department at the University of Oklahoma, said in an email that she observed similar practices in Cuba in the 1990s.

One doctor told Hirschfeld that not encouraging abortions for fetuses with abnormalities “might raise the infant mortality rate.” She said Cuba lacks neonatal intensive care wards that would prevent the deaths of infants with genetic defects, creating additional pressure to abort them and keep mortality rates low.

“The Cuban government’s approach to health and health care seems to prioritize the health of ‘the revolution’ above the health of individual patients,” she said. “This means doctors must hit specific statistical targets for their communities.”

Cuba’s life expectancy statistics are also disputed.

The United States has a life expectancy of 78.62 years compared to 78.05 in Cuba, according to CIA estimates. Data from the Pan American Health Organization (PAHO), by contrast, gives Cuba a slightly higher life expectancy.

Hirschfeld said there is reason to be “skeptical” of PAHO’s data because it relies on self-reported health statistics that are not independently verified.

Cuban officials have been reluctant to acknowledge disease outbreaks in the last couple decades despite multiple reports. A cholera outbreak beginning in July 2012 sickened hundreds and killed at least three people.

Hirschfeld said she contracted dengue fever while in eastern Cuba and was placed in a crowded hospital, where no medications were offered and medical assistance was limited. Patients who could walk helped the more severely ill, and all of them were expected to have their own dishes and utensils.

Cuba actually eradicated diseases such as smallpox and yellow fever in the early 1900s—before the United States did, Stusser said. However, Castro’s nationalization of the health system banned private initiatives and public-private partnerships, hampering Cuba’s biotechnology industry and drug development.

Cuba now has a glut of poorly trained family doctors, and many of the best health care facilities are reserved for elites and foreigners, Stusser said. Thousands of doctors have defected.

A spokesperson for Harkin did not respond to a request for comment on this article.